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New York Attorney General Letitia James joined 38 other state attorneys general Monday who together urged the U.S. Congress to remove three federal-law “barriers … that we cannot change at the state level” that they say are preventing many health care providers from providing effective opioid-disorder treatments.

In a letter to congressional leaders, including Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi, the 39 state A.G.s targeted “three significant barriers” to treating opioid use disorder, including a “cumbersome, out-of-date” federal privacy rule on patient treatment records; “unnecessary [federal] burdens” on the prescription of a key treatment drug; and a federal exclusion stopping state Medicaid programs from receiving certain reimbursements.

The detailed, three-page letter began by stating that the 39 state A.G.s “share [the U.S. Congress’] concern about the impact of the opioid epidemic on our country.” It moved to citing disturbing statistics about the epidemic, such as the crises resulting in more American deaths in two years than in the Vietnam War; more than half of the nation’s more than 70,000 drug overdose deaths in 2017 involving an opioid; and the impact of the crises being “so pervasive” that U.S. life expectancy has declined for three years in a row for the first time since the 1918 influenza pandemic.

“This loss of life and … major health consequences are matched by significant and continuing costs imposed on our criminal justice and social service systems,” the letter stated.

In addressing specific requests of Congress, the state A.G.s, including James, asked that applicable federal privacy rules found in 42 CFR Part 2 be replaced by “the effective and more familiar privacy rules” found in the Health Insurance Portability and Accountability Act (HIPAA).

“The complexities of complying with 42 CFR Part 2 often prevent general practice providers from even attempting to treat patients with substance use disorders through the use of medication-assisted treatment (MAT)”—which the A.G.s said is a “highly effective” approach combining medications with counseling and behavioral therapies—“because—while providers are familiar with how to comply with the privacy requirements of HIPAA—they may be intimidated by the requirements of 42 CFR Part 2.”

Next, the A.G.s asked that Congress pass H.R. 2482, the “Mainstreaming Addiction Treatment (MAT) Act,” and “eliminate unnecessary burdens on buprenorphine prescribing” created by the Drug Addiction Treatment Act of 2000 (DATA 2000).

“DATA 2000 was a step forward in substance use disorder treatment because it allowed the treatment of opioid use disorder in an office-based setting,” the state law enforcement leaders wrote. “However, it created a cumbersome bureaucratic system whereby providers who wish to prescribe buprenorphine in an office-based setting must prove to the Substance Abuse and Mental Health Services Administration (SAMHSA) that they have taken special trainings and then apply to the Drug Enforcement Administration (DEA) for a special DEA ‘X’ number to indicate when buprenorphine is being prescribed to treat substance use disorder.”

“Buprenorphine should not be singled out from all other drugs because it is a treatment for substance use disorder,” they continued, adding that “in our effort to eliminate this antiquated policy that restricts a healthcare provider’s ability to prescribe buprenorphine, we are joined by a coalition of 22 states, led by the New York State Department of Health, seeking … this change.”

H.R. 2482 “would address this issue by eliminating the redundant and outdated requirement that practitioners apply for a separate waiver through the DEA to prescribe buprenorphine for the treatment of substance use disorder,” the A.G.s said.

Finally, the attorneys general asked that congress “fully repeal” the federal Institutions for Mental Diseases exclusion, which, they said, “generally prohibits state Medicaid programs from receiving federal reimbursement for adults between 21 and 65 receiving mental health or substance use disorder treatment in a residential treatment facility with more than 16 beds.”

“This arcane federal policy, while well intentioned at its inception to encourage treatment in community-based settings, has proven to detrimentally limit states’ ability to provide the full continuum of clinically appropriate care for Medicaid enrollees with a substance use disorder,” the A.G.s said.

Media relations representatives for House Speaker Pelosi did not respond to a request for comment. Media relations representatives for Senate Majority Leader McConnell could not be reached for comment.

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AGs call on Congress to remove barriers to treatment for opioid use disorder

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